Oncology: Pathways to Progress

Cancer is a disease of endless reinvention, one that is increasingly understood as a collection of rare—and mostly treatable—conditions rather than the impregnable, death-dealing monolith portrayed in popular culture. Advances in our knowledge of the biology behind cancer are leading to new options for treatment, the most important of which is precision targeting of therapies tagged to the genetic profiles of individual patients. The array of new tools presents an enormous opportunity, but there is also the burden of complexity: to find and then transform all this new science into technologies that deliver clinical results to patients, demonstrate value to payers, and lead to the broad public health outcomes that society expects. To help address this challenge, Pharm Exec recently convened a cross-section of industry experts to review current and pending efforts to turn great science into good practice. The sum of the discussion, presented in the following Q&A: Not just courage but coordination, with a heavy dose of cooperation, is required to defeat the proliferating ethos of the cancer cell—biology's ultimate non-conformist. —William Looney, Editor-in-Chief

Managing complexity: the pathways prescriptive

William Looney, Pharm Exec: Numerous surveys find that oncology is the therapeutic segment where it is most difficult to demonstrate value to payers. Several of our participants today—including McKesson Specialty Health and the National Comprehensive Cancer Care Network [NCCN]—are working closely with providers, payers, and other stakeholders to improve the transparency of these relationships and strengthen standards for evidence-based, high quality care. Can we review quickly what initiatives are underway and determine their strengths and weaknesses in shaping institutional behavior?

Participants

Kevin Coker, McKesson Specialty Health: The treatment of cancer is highly dependent on innovation. The drive to leverage personalized medicine, investigate the increasing number of potential therapeutic agents, and better utilize technology has led to significant cost increases in care management. The annual cost of cancer care is now $150 billion in the United States alone, and it continues to rise. Drugs account for a highly visible share of the total, which can leave our industry exposed. However, we are also part of the solution, by contributing to the efficient, affordable use of resources in a way that leads to the best outcomes. The value we bring has to be grounded in evidence, observed and measured in real time, under active clinical practice. You cannot do that without keeping the focus squarely on the individual patient: if medicine is now personalized medicine, then the therapies we offer must be targeted therapies.

This is good for the patient—but it comes at a cost. Targeted therapy is representative of a new, much more complex business model, where the imperative is to conduct more and more clinical studies around a precisely differentiated patient base that adds to the recruitment burden, making trials more expensive and challenging to conduct. In working with the industry to bring 43 anti-cancer agents to market over the past few years, we know that the overarching priority is to find better ways to screen these patients efficiently. US Oncology Research is investing heavily in technology to help find these narrower patient populations. We use a model that allows research sites to open where those patients are actually receiving treatment, so we can leverage the scale of the 900 experienced physicians affiliated with us. Investments in companion diagnostics that match patients with the right drug are also critical when we are making the case to payers.